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1505 Woodview Ave W From:ALLSTAR CONSTRUCTION 19529427464 05/07/2014 10:19 #166 P.035/037 15x1, t S03, 1 Su; l9.) 004 U ~ eLo PNQ UV Use BLUE or BLACK Ink JIMA I For Office Use j ' j Permit *I n,4-7-0 Clt y of Eajan ~ Permit Fee' 1 3830 Pilot Knob Road Eagan MN 55122 j Date Received: j Phone: (651) 675-5675 I Q~(Z 1 Fax: (651) 675-5694 1 Staff: Q V t I I 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 5-1-ILA Site Address: H LJCA;. IC;6 WOOd EV Wc~i fc err ~w~~~) [,._.r-_ ~ Name: S - r CID, mT~.e.,,. .~...,...,.y~ Pho Resident/ E Owner !Address/ City l Zip: (PH3 ~ W , PArkWOWI P U4 h 6U d t f MN G53t-H Applicant is: Owner Contractor PPP Type of Work Description of work: Tf.ay Ofd ~ P,0 Construction Cost:. $Zk (1W -OU v Multi -Family Building: (Yes X / No Company- l tia►y Ulmlr~nc pn M hQIQIt MGnf U-b Contact: ~ the MetheYaan ~ Contractor Address: 51LF)1Y1GIVISh111 S-h_ -I0?1 city: Mapit Ploifn Q i State: N Zip: 5x135 Phone: - Email: 01V1t 0G1(IS1 V . bL License* Fu',1o315)5 Lead Certificate M N PE- ICAVI - 0 If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? e _Yes No If yes, date and address of master plan: Licensed Plumber: Phone: k K p' Mechanical Contractor: Phone: & P; Sewer & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of i the information maybe classified as non public if you provide specific reasons that would permit the City to conclude that they are trade secrets., CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.goi)herstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exteriorwork authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. X_ .,uftlg Mc~e~-mutt x Applicant's Printed Name Applicant's Signature Page 1 of 3